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ACI Clinic now offers all new patient forms online. So please complete and submit all the forms online at your convenience before your first visit. Our staff will review them. It will save your time in the office.

New Patient Online Forms - Required

This lets us know the history and current state of you health. What question, concerns, goals, regarding wellness can we help you with? Let us know! 

Click Here for Online Registration and Medical History

Click Here for Insurance Form

Click Here for Pain Diagram Form

Click Here for HIPAA Consent Form

Click Here for Consent for Acupuncture Form

Click Here for Consent for Chiropractic Form

Information For You To Keep

If you are a patient of Ke Zang, E.A.M.P., L.Ac, please download & keep Patient Notification of Ke Zang EAMP's Qualifications and Scope of Practice for your reference.

ACI Clinic & Wellness Center 

You may also download above forms in PDF for reference 

If you do not already have AdobeReader® installed on your computer, Click Here to download. 

Download Registration Form

Download Pain Diagram Form

Download HIPAA Form

Download Consent for Acupuncture Form

Download Consent for Chiropractic Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding! Download & Print Form